Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease
Background Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop ment...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://doi.org/10.1161/JAHA.116.003630 |
| _version_ | 1811293112101765120 |
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| author | Viola Vaccarino Kobina Wilmot Ibhar Al Mheid Ronnie Ramadan Pratik Pimple Amit J. Shah Ernest V. Garcia Jonathon Nye Laura Ward Muhammad Hammadah Michael Kutner Qi Long J. Douglas Bremner Fabio Esteves Paolo Raggi Arshed A. Quyyumi |
| author_facet | Viola Vaccarino Kobina Wilmot Ibhar Al Mheid Ronnie Ramadan Pratik Pimple Amit J. Shah Ernest V. Garcia Jonathon Nye Laura Ward Muhammad Hammadah Michael Kutner Qi Long J. Douglas Bremner Fabio Esteves Paolo Raggi Arshed A. Quyyumi |
| author_sort | Viola Vaccarino |
| collection | DOAJ |
| description | Background Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress‐induced myocardial ischemia (MSIMI). Methods and Results We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent 99mTc‐sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more‐adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4‐fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. Conclusions Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group. |
| first_indexed | 2024-04-13T04:56:33Z |
| format | Article |
| id | doaj.art-d859645d993249d3a41919d7fe781dce |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T04:56:33Z |
| publishDate | 2016-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d859645d993249d3a41919d7fe781dce2022-12-22T03:01:29ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802016-09-0159n/an/a10.1161/JAHA.116.003630Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart DiseaseViola Vaccarino0Kobina Wilmot1Ibhar Al Mheid2Ronnie Ramadan3Pratik Pimple4Amit J. Shah5Ernest V. Garcia6Jonathon Nye7Laura Ward8Muhammad Hammadah9Michael Kutner10Qi Long11J. Douglas Bremner12Fabio Esteves13Paolo Raggi14Arshed A. Quyyumi15Department of Epidemiology Rollins School of Public Health Emory University Atlanta GADepartment of Epidemiology Rollins School of Public Health Emory University Atlanta GADepartment of Medicine Emory University School of Medicine Atlanta GADepartment of Medicine Emory University School of Medicine Atlanta GADepartment of Epidemiology Rollins School of Public Health Emory University Atlanta GADepartment of Epidemiology Rollins School of Public Health Emory University Atlanta GADepartment of Radiology Emory University School of Medicine Atlanta GADepartment of Radiology Emory University School of Medicine Atlanta GADepartment of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GADepartment of Medicine Emory University School of Medicine Atlanta GADepartment of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GADepartment of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GADepartment of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta GADepartment of Radiology Emory University School of Medicine Atlanta GADepartment of Epidemiology Rollins School of Public Health Emory University Atlanta GADepartment of Medicine Emory University School of Medicine Atlanta GABackground Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress‐induced myocardial ischemia (MSIMI). Methods and Results We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent 99mTc‐sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more‐adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4‐fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. Conclusions Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group.https://doi.org/10.1161/JAHA.116.003630ischemiaischemic heart diseasesex differencesstresswomen |
| spellingShingle | Viola Vaccarino Kobina Wilmot Ibhar Al Mheid Ronnie Ramadan Pratik Pimple Amit J. Shah Ernest V. Garcia Jonathon Nye Laura Ward Muhammad Hammadah Michael Kutner Qi Long J. Douglas Bremner Fabio Esteves Paolo Raggi Arshed A. Quyyumi Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemia ischemic heart disease sex differences stress women |
| title | Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease |
| title_full | Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease |
| title_fullStr | Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease |
| title_full_unstemmed | Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease |
| title_short | Sex Differences in Mental Stress‐Induced Myocardial Ischemia in Patients With Coronary Heart Disease |
| title_sort | sex differences in mental stress induced myocardial ischemia in patients with coronary heart disease |
| topic | ischemia ischemic heart disease sex differences stress women |
| url | https://doi.org/10.1161/JAHA.116.003630 |
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